Floor Statements

I rise to speak in support of the Foreign Manufacturers Legal Accountability Act of 2009, which I am introducing today with the ranking member of the Judiciary Committee, Senator Sessions, and Senator Durbin. This bipartisan bill is an important step in protecting American consumers and businesses from injuries caused by defective products manufactured outside the United States. Those products hurt American consumers--they lead to serious injuries, and even death--and they hurt the American businesses that must deal with angry customers, product recalls, and unusable inventory.

The list of recent examples of Americans injured by defective foreign products is shocking. Last year, a contaminated blood thinner from a foreign manufacturer caused severe medical reactions and contributed to numerous deaths. In 2006, a foreign-made, lead-tainted charm bracelet claimed the life of a 4-year-old. The autopsy demonstrated that the charm was 99 percent lead, 1,650 times more than the 0.06 percent lead limit specified in enforcement guidelines for children's jewelry. Imported food products from seafood to honey have been contaminated with unthinkable chemicals, including veterinary drugs banned in domestic production, potentially harmful antibiotics, and unapproved food additives. Sixty million packages of pet food contaminated with tainted wheat gluten have been recalled in the last two years. Substandard tires have failed, leading to fatalities. Most recently, defective drywall imported from China has been found to contain excessively high levels of sulfur, causing houses to smell like rotten eggs, corroding copper wiring, and making expensive appliances fail. Thousands of homes may be affected.

At a hearing that I chaired in May, the Subcommittee on Administrative Oversight and the Courts explored the legal hurdles facing consumers who are injured by defective foreign products and by businesses that find that their foreign partners refuse to honor their contracts. These hurdles allow foreign manufacturers to continue to injure American businesses and consumers, and also put American manufacturers at a competitive disadvantage since they allow foreign manufacturers to offer cheaper products that do not comply with American safety requirements. Two major hurdles to proper accountability are the inability to serve

process on the foreign manufacturer and the ability of that foreign manufacturer, even if served, to evade the jurisdiction of American courts. As the witnesses testified at the hearing, legislation that addresses these issues is necessary and appropriate. The Foreign Manufacturers Legal Accountability Act addresses both concerns.

The first problem, the inability to serve process on a manufacturer, essentially means that it is difficult for an American to give a foreign manufacturer the documents necessary to give it the legally required notice that it is the subject of a lawsuit. This sounds like a simple step, and it should be. Unfortunately, however, it is very hard to serve process on foreign companies abroad. As witnesses explained at the hearing in May, service abroad is complicated by the Hague Convention on the Service Abroad of Judicial and Extra Judicial Documents in Civil and Commercial Matters, to which the United States is a signatory. Under that convention, a complaint must be translated into the foreign language, transmitted to the Central Authority in the foreign country, and then delivered according to the rules of service in the home country of the defendant. This can cause months and even years of delay, not to mention great expense for Americans.

The Foreign Manufacturers Legal Accountability Act will allow Americans to overcome that procedural hurdle by serving legal papers inside the United States on registered agents of foreign manufacturers. The bill requires the heads of federal government agencies such as the Food and Drug Administration to pass regulations requiring that foreign manufacturers of products regulated by their agencies register an agent who will accept service of process. It allows regulators to exclude manufacturers who only import a minimal amount of products into the United States. It imposes a minimal burden on foreign manufacturers, since they would only have to appoint one agent to accept service of process for all state and federal regulatory and civil actions anywhere in the United States. The bill allows the manufacturer to choose any location for that agent with a ``substantial connection to the importation, distribution, or sale of the products of such foreign manufacturer or producer.'' This clear and straightforward system will allow Americans to commence their lawsuits fairly and promptly, and ensure that foreign manufacturers have proper and fair notice of the proceedings brought against them. It will not conflict with American obligations under the Hague convention, since that convention applies to service of process on foreign manufacturers in their home countries, not in the United States.

The second hurdle, the inability to establish personal jurisdiction over foreign manufacturers, can end a lawsuit against a foreign manufacturer before it even begins. Think about how unfair this is. A foreign manufacturer sells its defective products in the United States, injures American consumers and businesses, and then argues that it is not subject to the courts in the state where the American was injured-- in legal parlance, that the courts do not have personal jurisdiction over it. As witnesses explained at the hearing, foreign manufacturers raise this technical legal defense to avoid liability even when serious injuries or even death have been caused by their products--their defective tires, fireworks, exercise equipment, bikes, and toys.

The Foreign Manufacturers Legal Accountability Act will enable injured Americans to surmount this hurdle. It will make clear to foreign manufacturers that by importing their products into the United States and by registering an agent in the United States, they are consenting to the jurisdiction of the courts in the state where their agent is located. By consenting to jurisdiction, the manufacturers will avert unnecessary and expensive legislation about technical legal issues and allow courts to settle the merits of disputes. This approach is fair to foreign manufacturers since all American manufacturers are subject to the jurisdiction of the courts of at least one state. This bill therefore complies with the trade principle that we should not subject foreign manufacturers to burdens not already imposed on domestic manufacturers.

Indeed, the Foreign Manufacturers Legal Accountability Act is ultimately about fairness. We all know American manufacturers comply with regulations that ensure the safety of American consumers and businesses. When they fail to do so, they must answer to regulators and are held accountable through the American tort system. Unfortunately, however, foreign manufacturers are not being held to the same standards--injuring American consumers and businesses, and putting American manufacturers at a competitive disadvantage. We must level the playing field for all manufacturers and provide justice for American consumers and businesses. The Foreign Manufacturers Legal Accountability Act will allow us to make a major step in that direction. It covers major product categories including consumer goods, drugs, cosmetics, and chemicals, and it requires relevant agencies to study workable approaches to ensure that foreign food producers also are brought within the ambit of the American legal system.

Protecting Americans and holding foreign manufacturers accountable when their products harm American consumers and businesses is a bipartisan issue. Everyone agrees that we should do what we can to keep Americans safe from defective products. So too, I think, do we all agree that American companies should not be at a competitive disadvantage to their foreign counterparts. The Foreign Manufacturers Legal Accountability Act builds on those fundamental agreements. I am grateful to my colleagues Senator Sessions and Senator Durbin for their hard work on this bill and look forward to working with my colleagues on both sides of the aisle to see it passed into law.

Mr. President, I rise today to introduce legislation that would help families struggling with medical debts overcome hurdles that under current law make it difficult for them to find relief in the bankruptcy system. With medical costs at an all-time high and the unemployment rate hovering near 10 percent nationwide--and 12.4 percent in my home State of Rhode Island--too many individuals and families struck with injury and illness have no other option but to file for bankruptcy. According to a recent Harvard University study, health care-related costs have been a primary driver of personal bankruptcy filings, contributing to over 62 percent of filings in 2007.

The statistics are as shocking as the personal stories are heartbreaking. Countless Rhode Islanders have written to me during my time in office asking for help with crippling medical costs, and I want to share just two of their stories with you today.

Adam, a 23-year-old from Bristol, recently underwent surgery for cancer. Adam's treatment plan requires him to undergo a CT scan every 2 months. While his insurance initially paid for his health costs, he received word not long after his surgery that his policy was ``maxed out'' and that he would have to pay $6,700 out of pocket for an upcoming CT scan. As of today, Adam, a young man just starting his adult life, has $20,000 in medical debt and reports that he ``cannot see any light at the end of the tunnel.''

Robert, a veteran and retiree also from Warwick, suffered a major heart attack in November of 2004. Although he had health insurance, Robert was responsible for paying a $2,000 deductible plus 20 percent of the cost of his care. After 40 years of working and saving, these medical costs wiped him out, and he had to sell his home.

Adam and Robert have both suffered unexpected medical costs that have turned their lives upside down. These Rhode Islanders, like millions of others nationwide, may be forced to file for bankruptcy to get a clean start--but when they do, they will learn that the bankruptcy process can be time consuming and costly and ultimately may not allow them to stay in their homes.

The legislation that I am introducing today, the Medical Bankruptcy Fairness Act of 2009, would help people who because of medical costs have no other choice but to file for bankruptcy. The bill would waive procedural hurdles so that Adam and Robert would have the option of a speedier, less expensive, and more efficient bankruptcy. To begin with, it would waive credit counseling requirements for these debtors. Such requirements have little relevance to people whose debt stems not from poor budgeting but, rather, from uncontrollable medical expenses. The bill would also waive the so-called ``means test,'' making the filing process quicker and less costly and making sure that people have the ability to file to have their debts discharged in chapter 7, as opposed to a chapter 13 plan under which they would have made debt payments for 3 to 5 years.

In addition to removing these procedural hurdles, the Medical Bankruptcy Fairness Act would give people with high levels of medical debt the ability to retain at least $250,000 in home value through the bankruptcy process. The ``homestead exemption'' is one of many aspects of bankruptcy law that looks to the laws of the individual States. While filers in some States already have the ability to preserve home equity at this level, a number of States offer homestead exemptions of $5,000 or less. With the average home price nationwide around $200,000, the $250,000 exemption included in this bill will allow the majority of individuals and families crushed by medical debt to keep their homes.

Finally, the bill would eliminate an obstacle that prevents many bankruptcy filers from accessing the chapter 7 bankruptcy system, which as I mentioned earlier is the simplest and most efficient form of bankruptcy. Because attorneys' fees are ``discharged'' at the end of a chapter 7 bankruptcy, attorneys generally require the upfront payment of fees in chapter 7 proceedings. Many debtors who would be better off filing for a quicker and less costly bankruptcy in chapter 7 are forced to file in chapter 13 because they don't have enough cash to pay the attorney. The Medical Bankruptcy Fairness Act would make attorneys' fees nondischargeable in chapter 7 bankruptcies, as in chapter 13 bankruptcies, making it easier for debtors to elect the more efficient chapter 7 proceeding.

Before I conclude, I want to acknowledge the hard work of my colleague from Massachusetts, Senator Kennedy, on the issue of medical debt. Senator Kennedy offered amendments during the consideration of the 2005 bankruptcy reforms that would have given people struggling with medical debts treatment similar to that which they would get under the Medical Bankruptcy Fairness Act. Unfortunately, those amendments were voted down. I look forward to working with Senator Kennedy to make sure that we don't miss another opportunity to help Americans struggling with medical debt.

There are people in every State suffering from medical hardship and related debts who would benefit from this legislation. I urge my colleagues to work with me to pass it to Adam and Robert and the millions like them nationwide a clean start in bankruptcy.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 101, S. 423.

Mr. President, I ask unanimous consent that the Senate proceed to Calendar No. 129, H.R. 1016, the House companion; that all after the enacting clause be stricken and the text of S. 423 be inserted in lieu thereof; the bill, as amended, be read a third time and passed; the motions to reconsider be laid upon the table; that upon passage of H.R. 1016, S. 423 be returned to the calendar, with no intervening action or debate.

Mr. President, I ask unanimous consent that the Finance Committee be discharged from further consideration of H.R. 3325 and that the Senate then proceed to its consideration.

Mr. President, I ask unanimous consent that the bill be read three times, passed, and the motion to reconsider be laid upon the table; further that any statements be printed in the Record.

Mr. President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration of S. Res. 40, and the Senate proceed to its immediate consideration.

Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the resolution be printed in the Record.

Mr. President, I ask unanimous consent that the Senate proceed to the consideration of S. Res. 248, which was submitted earlier today.

Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table.

Mr. President, I ask unanimous consent that the Senate proceed to the consideration of S. Res. 249, which was submitted earlier today.

Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 250, submitted earlier today.

Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and that any statements relating to the resolution be printed in the Record.

Mr. President, I suggest the absence of a quorum.

Mr. President, I am honored to join my distinguished colleague from New Jersey here today on the Senate floor to speak in support of the confirmation of Judge Sonia Sotomayor as the next Associate Justice of the U.S. Supreme Court.

I had the privilege to sit on the Judiciary Committee for her confirmation hearing, and I join all of my committee colleagues on both sides of the aisle who have complimented Chairman Leahy for a very well-run hearing. I was proud to vote for Judge Sotomayor in the Judiciary Committee, and I will be proud to vote for her confirmation here on the Senate floor.

Judge Sotomayor's remarkable education and professional qualifications, her commitment to public service, her uncontroversial 17-year record on the Federal bench--longer than any nominee in 100 years--her responsiveness and patient judicial temperament at the hearing, all confirm to me her pledge that she will respect the role of Congress as representatives of the American people; that she will decide cases based on the law and the facts before her; that she will not prejudge any case but listen to every party that comes before her; and that she will respect precedent and limit herself to the issues that the Court must decide; in short, that she will use the broad discretion of a Supreme Court Justice wisely.

I applaud those of my colleagues who have acknowledged that Judge Sotomayor falls well within the mainstream of the American legal profession. At the same time, it is disappointing that so few Republican colleagues have been willing to recognize her clear qualifications for our highest Court. The nearly unanimous party-line opposition offered by Republicans in committee and here on the floor raises serious concerns whether some of my colleagues would ever be willing to vote for anyone outside of the Federalist Society. To my Republican colleagues in opposition, I ask: What Democratic nominee would you vote for, if not Judge Sotomayor, with her vast experience, her commitment to the rule of law, proven indisputably over 17 years, her remarkable credentials, and her extraordinary moving American life story?

Unfortunately, Judge Sotomayor seems to be walking proof that conservative political orthodoxy is now their confirmation test, masked as concerns about judicial activism. Many of my Republican colleagues unfairly ignore her long record to base criticisms on strained interpretations of a few routine and appropriate circuit court opinions and a few remarks taken out of context. Those criticisms feel, quite frankly, like the criticisms of someone who is determined to find fault with a nominee.

Take, for example, the New Haven firefighters case. The per curiam opinion in Ricci was based on controlling second circuit and Supreme Court precedent. The sixth circuit took the same approach in a similar case arising in Memphis. The role of a circuit court is to follow existing precedence of the Supreme Court and the circuit court. That is what the Ricci per curiam did. The Supreme Court may have reversed, but it did so 5 to 4 on the basis of an entirely new test it created. It is absurd to call Judge Sotomayor an activist for following existing precedent. If you want a judicially conservative opinion, the Ricci per curiam is just that.

The decision in Maloney was also properly conservative in a judicial sense. It approaches with caution a newly minted and narrowly enacted constitutional right whose extension to the States would upset generations of practice and experience by sovereign States regulating guns within their borders. A seventh circuit panel, with two very prominent conservative judges on it, correctly did exactly the same thing. A ninth circuit panel reached a different conclusion, and then that decision was vacated by the circuit to reconsider that case en banc.

Rather than engaging in a serious inquiry of Judge Sotomayor's fitness for the Supreme Court, many of my colleagues have made this nomination into a referendum on whether the newly minted right to bear arms should be incorporated against the States for the first time in our Nation's history. This is doubly unfair. First, Judge Sotomayor could not answer questions at her hearing that would suggest how she would rule in later cases. That is inappropriate. Second, it is inappropriate to try to force on a judge a particular political view as the price of admission to her judicial office.

Criticisms of a few stray lines in Judge Sotomayor's various speeches are equally perplexing. Judge Sotomayor's long and noncontroversial 17- year judicial record should allay any concerns about those remarks, but so should the context of those speeches themselves. The ``wise Latina'' comment we have heard so much about came in a speech that argued how important it is for judges to guard against bias and to be aware of their own prejudices. Is it not better and truer to admit that we all have prejudices we must manage than to pretend that White males form some sort of ideal cultural baseline that has no biases?

Senator Specter said it well at the committee vote. ``There is nothing wrong with a little ethnic pride and a desire to encourage her law student audience.'' Maybe we should try to put ourselves in their shoes. Perhaps, with a little empathy ourselves, it might be easier to understand how a profession and a judiciary dominated by White males might look to those young law students, and how important a little encouragement to them might be that their experiences might give them something valuable to contribute; that they are not the exception; that they are welcome and fully a part of our society, and that they bring something valuable not only to the profession but, one day, perhaps, even to the judiciary.

In sum, my Republican colleagues' criticisms of Judge Sotomayor appear to be grounded in conservative political idealogy rather than legitimate concern that Judge Sotomayor is not fit to serve on the Supreme Court, grounded in a desire for more of the rightwing Justices who in recent years have filled out a conservative wing on the Supreme Court. That wing has marched the Court deliberately to the right in the last few years, completely discrediting the Republican claim that judges are mere ``umpires.''

Jeffrey Toobin is a well-respected legal commentator, particularly focusing on the Supreme Court. He has recently reported:

In every major case since he became the Nation's 17th Chief

Justice, Roberts has sided with the prosecution over the

defendant, the State over the condemned, the executive branch

over the legislative, and the corporate defendant over the

individual plaintiff. And is it a coincidence that this

pattern has served the interests and reflected the values of

the contemporary Republican Party?

Some coincidence. Some umpire.

The phrase ``liberal judicial activism'' is now conservative speak for any outcome the far right dislikes. They did not use it when the conservative block of the Court announced, by the barest of a 5-to-4 margin, an individual right to bear arms that had gone unnoticed by the Supreme Court for the first 220 years of its history. If that is not an activist decision, the term has no meaning. It is just activism that conforms with a deliberate Republican strategy of many years duration to pack onto America's courts proven conservative judges who will deliver the political goods they seek.

Setting aside all this politics, we should also never forget, never overlook the historic role that judges play in protecting the less powerful among us. We should always appreciate how a real-world understanding of the real-life impact of judicial decisions is a proper and necessary part of the process of judging.

Judge Sotomayor's wide experience, I hope, will bring her a sense of the difficult circumstances faced by the less powerful among us--the woman on the phone, shunted around the bank from voice mail to voice mail for hours as she tries to find someone to help her avoid foreclosure for her home; the family struggling to get by in the neighborhood where the police only come with raid jackets on; the couple up late at night at the kitchen table after the kids are in bed sweating out how to make ends meet that month; or the man who believes a little differently or looks a little different or thinks things should be different. If Justice Sotomayor's wide experience gives her empathy for those people so that she gives them a full and fair hearing and seeks to understand the real-world impact of her decisions on them, she will be doing nothing wrong--nothing wrong by the measure of history, nothing wrong by the measure of justice.

Experience, judgment, wise use of discretion, and a willingness to stand against oppression have always been the historic hallmarks of a great judge.

As to experience, Justice Oliver Wendell Holmes famously explained:

The life of the law has not been logic: it has been

experience. The felt necessities of the time the prevalent

moral and political theories, intuitions of public policy,

avowed or unconscious, even the prejudices which judges share

with their fellow-men have had a good deal more to do than

the syllogism in determining the rules by which men should be

governed. The law embodies the story of a nation's

development through many centuries, and it cannot be dealt

with as if it contained only the axioms and corollaries of a

book of mathematics.

As to judgment, Justice John Paul Stevens has observed:

[T]he work of federal judges from the days of John Marshall

to the present, like the work of the English common-law

judges, sometimes requires the exercise of judgment--a

faculty that inevitably calls into play notions of justice,

fairness, and concern about the future impact of a decision.

As to discretion, Justice Benjamin Cardozo wrote:

The judge, even when he is free, is still not wholly free.

He is not to innovate at pleasure. He is not a knight-errant,

roaming at

will in pursuit of his own ideal of beauty or of goodness. He

is to draw his inspiration from consecrated principles. He is

not to yield to spasmodic sentiment, to vague and unregulated

benevolence. He is to exercise a discretion informed by

tradition, methodized by analogy, disciplined by system, and

subordinated to ``the primordial necessity of order in the

social life.'' Wide enough in all conscience is the field of

discretion that remains.

And, as Alexander Hamilton explained in the Federalist Papers, courts were designed to be our guardians against ``those ill humors, which the arts of designing men, or the influence of particular conjunctures, sometimes disseminate among the people . . . and which . . . have a tendency . . . to occasion . . . serious oppressions of the minor party in the community.'' Those oppressions tend to fall on the poor and voiceless. But as Hamilton noted, ``[c]onsiderate men, of every description ought to prize whatever will tend to beget or fortify that temper in the courts: as no man can be sure that he may not be tomorrow the victim of a spirit of injustice, by which he may be a gainer to- day.'' We should not discard the wisdom of centuries.

Experience, judgment, discretion, and protection from oppression--the standard for judges of Hamilton, Holmes, Cardozo, and Stevens. History stands with them. And thoughtful people will note that empathy is a common thread through each of these characteristics.

Why might empathy matter? When might it make a difference? Take, for example, the history of the Colfax massacre.

Go back to Sunday, April 13, 1873 when a gang of White men murdered more than 60 Black freedmen in Colfax, LA. Some were burned in a courthouse where they had taken refuge; others were shot as they fled the burning courthouse; others were taken prisoner and then executed. U.S. Attorney James Roswell Beckwith determined to prosecute white citizens involved in the Colfax Massacre--not a popular call in those days. The case was tried before a U.S. District Judge William B. Woods, who determined that rule of law should prevail in his district. Predictably, polite White society was outraged. It took notable human empathy in that place and time to see the massacre of the Black freedmen as a crime, and to contemplate trying White men for the murder of Black men. The case was brought as one of the first applications of the Federal Enforcement Act, implementing the Constitution's new 14th amendment, so there was wide room for judicial discretion in that uncharted area of law--no ``balls and strikes'' here. District Judge Woods assured a fair trial, but he also was prepared to honor Congress's desire that outrages upon the Black community should be punished as crime. He had sufficient empathy with the widows and children of the slain freedmen to take seriously their need for vindication, and he had sufficient courage to face the scorn and anger of the White community.

Another judge was involved, U.S. Supreme Court Justice Joseph P. Bradley, who under the procedural rules of the time ``rode circuit'' for Louisiana, and could sit in on trials. And sit in he did. He had no sympathy for the former slaves, and little regard for Congress's intent to punish the abuse of freedmen. Disagreeing from the trial court bench with Judge Woods, Justice Bradley found repeated technical faults with the indictments, took a restricted view of the authorities of the 14th amendment, dismissed the charges, and released the defendants to flee, on low bail, pending an appeal.

The U.S. Supreme Court upheld its colleague Bradley's opinions, thereby gutting the 14th amendment and the Enforcement Act for a generation, and a wave of murder and violence by Klansmen and White League members, emboldened by de facto immunity from prosecution, swept the South. Reconstruction was vitiated in those weeks. Justice, for the murder of a Black man by a White, departed the South for nearly a century.

History and the law ultimately proved district Judge Woods correct, but how much turned on the character of two judges: one who had the empathy to see Black men as victims of crime, and the courage to outrage White opinion by allowing the trial of White community leaders, before a mixed jury no less; the other a judge who valued the status quo, and recoiled from any shock to proper White opinion and authority; indeed, who was the reflection of that proper opinion.

That is what we mean by empathy, and while the divisions in our society are less today, there are still people who feel voiceless, whose voices a judge must be attuned to hear; there are still Americans who come to court bearing disadvantages that have nothing to do with the merits of their case. Empathy to look through those disadvantages to see the real merits of the case, even when it is unpopular or offends the power structure is the hallmark of a great judge. The words of Hamilton, Holmes, Stevens, and Cardozo I have quoted display it as history; the contrasting approaches of the two judges after the Colfax massacre display it as justice.

My Republican colleagues' misunderstanding of judicial history has led to a missed opportunity for bipartisan support of a highly qualified and moderate judge who falls well within the mainstream of American legal thought. We could be celebrating the first Latina justice of the Supreme Court as a great American achievement. Instead we are having to defend basic principles of American history from assault from the right. I hope that, as the future looks back on this day, it will be the historic nature of this nomination that will be remembered, not the strange and strained efforts to impose right-wing political orthodoxy on the courts that defend our constitutional rights.

I look forward to Judge Sotomayor's service as an excellent Supreme Court Justice. I will vote proudly for her confirmation.

Mr. President, I ask unanimous consent to have printed in the Record a letter of support of Justice Sotomayor from New York City's mayor, Michael Bloomberg.

I also ask to have printed in the Record a letter of support for Judge Sotomayor from former FBI Director Louis Freeh.

I yield the floor.

I ask my distinguished colleague from Iowa a question about prevention because it strikes me, if you are a community health center and you want to invest in a health prevention strategy that will help the community you serve have healthier lives and therefore lower the costs to the system for everyone--you put out the money for that program if you are the community health center, you have to staff it, you take all the risks, you do all the work, and yet the benefit of what you have done doesn't come back to you. It goes to private insurers, it goes to the Federal Government, it goes to patients and better health. But it makes it a very unfortunate business proposition for anybody who is doing this on their own, which suggests this is an important place for the Federal Government to invest because the market, by itself, will not take care of this because you invest and you don't get it back. You invest and it goes to the insurance company. You invest and it goes to Medicare.

I know Senator Brown wishes to make some statement. I wish to make that point because Senator Harkin's work has been so important on this, and I think that is an important thread.

I would be delighted to talk about that. But the first thing I would like to do is react to a point the distinguished chairman has just made regarding how ironic it is that some of our friends on the other side are so opposed to increasing competition in the insurance industry. One of the things that is particularly ironic is that a great number of our colleagues on the other side go home to their home States to a health insurance system that already is a public option for their business community, their workers' compensation system.

The two places you get health care are from the general health insurance marketplace and from the workers' compensation marketplace. You can get workers' compensation coverage, and it will cover small workplace injuries, it will cover catastrophic workplace injuries, it will cover temporary conditions, and it will cover lifetime chronic conditions. It has all of the elements of health insurance coverage and the need for it.

Well, when our colleague from Wyoming, the distinguished ranking member of the HELP Committee, goes home to Wyoming, he goes home to a single-payer public option for workers' compensation health insurance. So it can hardly by anathema to have a choice public option.

The distinguished gentleman, Senator McCain, who was the Republican candidate for President, goes home to Arizona to a competitive public plan providing workers' compensation health insurance in his home State.

The Republican leader himself, Senator McConnell, goes home to Kentucky, to a State where there is a public plan that delivers health insurance, a competitive public plan. And I suspect his employers like it and the people are comfortable with it.

Our colleague, Kay Bailey Hutchison, is shortly to go home to Texas to run for Governor. When she does, she will go home to a State that has a competitive public plan that delivers health care through the worker's compensation system.

Our distinguished friends in Utah, Senator Bennett and Senator Hatch, who have done so much work on health insurance issues over the years, go home to Utah, where their business community has a competitive public plan for delivering health insurance.

So, in addition to the irony of being against competition, their business communities, I believe, are highly favorable to a public plan that competes in the market to deliver health insurance that the business community funds, the workers' compensation health insurance market. So I guess ironies abound here.

I would also like to compliment Senator Brown for keeping it real here on the Senate floor and reading those letters and reminding us that when push comes to shove around here, it is not the nametags and the labels that matter, it is not ``socialized medicine,'' it is not ``government takeover,'' it is people who have real problems.

I was struck by a letter that was brought to my attention today. I do not know exactly what day it came in, but I saw it today. A working couple with a son, sort of the ideal American family, doing nothing wrong, doing everything right, playing by the rules, working hard. The son becomes grievously ill, has a very grave illness. Over the years, his condition worsens, and ultimately his disease takes his life. They were insured through this whole period, but the insurance was not enough. There were copays, there were limits, there was cost sharing. As a result of all of this, they are deeply in debt. They had to take time off work and spend time caring for him, and so they have had employment issues.

Now, this is, again, sort of the ideal American family. They are both working hard. They have a son whom they love. They are doing everything right, and they are playing by the rules. And because he got sick and because our health insurance system is such a nightmare for a family in that situation, they have lost their son, they have lost their savings, and they are about to lose their home. They are about to be put out of the house that has all of the memories of their son.

You know, there are people for whom this is very real, and we have to keep our eye on that ball and not on all of the smoke and all of the fear mongering that is happening around here. A lot of that smoke and fear mongering is happening around our public plan.

Well, it is not that complicated. It is competitive. It is fair. It has no special subsidies for people who are in that plan versus in competing private plans. It has no special advantage. And it honors President Obama's programs and the promise of all of the Presidential candidates that if you like the plan you have, you get to keep it. You are not forced out of anything.

So if it has no special advantages, if it has no special subsidies, why do we support a public option? Why is it better? Well, I would say that there are three reasons we can have some confidence that a public option will make a difference for the kind of people Senator Brown was talking about, the family I was talking about, people who suffer through our existing health care system.

The first is, a public plan does not need to take profit out of the system.

In 2007, in Rhode Island, one of our insurers, United Health Care, asked permission to remove $37 million as its profit in that year from Rhode Island back to its home headquarters. My State isn't as big as Ohio. It is not as big as Iowa or Connecticut. It is a small State. It has a million people. In one year to take $37 million out of that State, when they only had a 16-percent market share, think of that. A 16-percent market share in a State of a million people is about 160,000 folks they cover, assuming that everybody had coverage; $37 million out of those 160,000 people in 1 year gone for profits.

Stop doing that. Stop paying exorbitant salaries such as United Health Care's chief executive who got $124 million in salary. That is a lot of money that could go back into other things in health care. That could help families either get better coverage or pay lower premiums. So there is one thing--no profit, no excess cost.

The second is, you could have better dealings between insurers and providers and hospitals than we have right now. Fifteen percent of our health care costs from the insurance side goes to overhead and administration. Most of that goes to denying claims and making life difficult for providers, doctors, and hospitals, when they submit their bills. There is a war, a claims war going on right now between the insurance industry and doctors and hospitals. And 15 percent of what we pay for health care gets burned up on the insurance company side of that war. The insurance companies are bigger and smarter, and they set the rules. So you can bet that the doctors' side of responding to that costs more than 15 percent.

In fact, the Lewin Group has estimated that 36 percent of a provider's overhead cost goes to fighting with the insurance industry. Everybody in this place has had the experience or somebody they know or love has had the experience of trying to get a claim paid, having it be denied, submitting a bill, having it be denied, having to wait for treatment that you need while your doctor tries to get prior authorization from the insurance company that says: No, we need more papers. All of that is expensive. None of it provides any health care value, zero. It is all administrative overhead and nonsense.

In some cases it is big. I was at the Cranston, RI community health center. It is not a big organization. Rhode Island is not a big State. Cranston is not our capital city, not our biggest town. Its community health center does not have an enormous budget. They spend $300,000 every year on the consultants who help them try to negotiate this payment claims war they are stuck in--$300,000 a year. On top of that, 50 percent of their personnel time, half of their personnel time, goes to fighting with insurance companies. So you take a little place such as the Cranston community health center and you can tell them: Half of your personnel costs can go away or can be devoted to prevention, as the Senator from Iowa has suggested, instead of fighting with the insurance industry. That is an improved model. That is something the public option can pursue.

You don't have to fight the providers that way, and the amount of waste that is burned up on all of that warfare for no health care value whatsoever is an opportunity for this public option to achieve.

The third area is to more broadly change the busines model. There is a failed private insurance business model right now. It is pretty simple to summarize. No. 1, if they think you are going to get sick, they deny you insurance. You don't even get in the door. No. 2, if they make a terrible mistake and let you in the door and then you have the temerity to get sick, they look for a way to deny coverage. They go through the form and look for a mistake you might have made so they can throw it out. They find something that might have been a preexisting condition. They look for a loophole. If they are stuck, if they can't find a loophole, then they deny payment. They tell you that the coverage you need isn't what you need or they refuse to honor the doctor's bill when it comes through the door. But a business model for an entire industry of denying insurance to the people who they think will get sick and then denying coverage to the people who actually do get sick and, when they can't dodge their coverage responsibilities, denying payment to doctors or hospitals or trying

to have some person who is not even a doctor second-guess the coverage that your doctor tells you you need, that is a terrible business model. It has caused immense pain across the country, and it has been a disaster. There is a better business model. A public option can pursue it.

Yes, it would. And it is an important piece of this legislation that has received far too little attention so far in the debate. It has caused an immense amount of personal pain, human anguish, and suffering that our health care system causes.

The distinguished Senator from Ohio, Senator Brown, and I wrote an article about this. We wrote: Your health insurer should be your advocate, not your adversary. The community health insurance option will invest in prevention so that when you are healthy, you stay that way. It will invest in care management coordination, if you have a chronic condition, and it will fight for you, not with you, to get you the best possible care with the least possible hassle.

That is what this is all about. The new business model can look in these areas: Quality improvement. We know that improvement in the quality of care in this country can save dollars. But as we were saying earlier in our colloquy, it doesn't save money for the person investing in the quality. It saves it for the system. A public option will have the public purpose necessary to pursue those quality improvements that will drive down cost.

Health information infrastructure. We have the worst health information infrastructure in this country of any industry. The only industry that has worse information infrastructure is the mining industry. It is pathetic. But the same principle applies. The doctor investing in that equipment on their desk puts out all the money, takes all the risk, absorbs all the hassle, and the savings go to the insurance companies. So we are underinvested. A public option can make those investments in our electronic health record infrastructure.

Prevention strategies. I won't dwell on that because the Senator from Iowa has done such a good job already. Same principle: A public option can pursue the public purpose of protecting public health through prevention in a way that insurers never will because they don't have the financial interest at stake. Finally, you can develop new models of payment to make all those happen, because the way we pay for it now is piecework. Procedure by procedure, the more you do, the more you get paid. Not the healthier your patients are, the more you get paid; the more you do, the more you get paid.

There is enormous hope for the whole system. In fact, it may be the only hope for our whole system is to change that business model to a model that works on quality improvement, prevention, investment, payment reform, and electronic health record infrastructure for everybody. A public option will lead us in that way.

Perhaps you can trust the private insurance industry to do this, although they never have so far. But perhaps now suddenly something will change and you can trust them to start doing this for the first time, when they never did before. But I don't think it is a wise bet to put all of our eggs in that one basket. Give us a public option and let them compete. I think they can help transform this world.

The last thing I will say it is cost control. We have heard a lot about cost control on this subject. There is no better way to have cost control than to get a public option out there doing all these things-- stripping the excess profit out of the system, lowering the administrative costs, ending the warfare with providers that provides no value, and working to a business model founded on quality, prevention, electronic infrastructure, and clearer payment signals. That is where we need to go. The public option takes us there.

Nobody cares more about this than the distinguished chairman and particularly the people he has heard from in Connecticut. I would revert back to the chairman to discuss the personal aspects of this on the part of the people he serves.

I wanted to follow up on Senator Merkley's discussion of the different ways in which somebody who is watching this, and who is insured, can look forward to some benefit from all of this. A simple one would be to think, in your own experience, how often you have gone into your doctor's office and maybe been referred to a specialist or you brought a family member in and you had to take a clipboard and fill out on paper for the umpteenth time your personal health insurance, your billing information, your Social Security information, and whatever it is they want. You have to fill it out over and over again. That is the experience many people have with our health care system.

Compare that to going online at--pick one--say, Amazon. You log into Amazon and they say: Welcome, Sheldon Whitehouse. Good to have you back. Here are all the books you bought in the last year or so. Based on that, we think here are more books you might like. Choose something you would like, and your billing information is here.

Put those experiences side by side and show where our bill can take the American health care consumer, and what that means for quality of care, and not just for the convenience of not filling out the form, but when you are a pharmacy, it is connected to your laboratory, it is connected to your doctor, it is connected to the hospital, and you are the center of it, and all of it is private and secure. That is a new and better world for everybody, including those who have insurance.

Who has not had somebody they know go into a hospital and come out with a hospital-acquired infection? It has happened over and over. I have had a friend who went in for a simple knee surgery, arthroscopic surgery. He was a big athlete in college, and he needed a simple surgery on his knee. He got a hospital-acquired infection--a strong, big guy--and it nearly killed him. It took him out of work for weeks. Mercifully, he recovered and everything is fine. It was touch and go for a while, and the cost of all of that was tremendous from that hospital-acquired infection. He required weeks of medical care. Everybody has had that experience. About 100,000 people every year-- Americans we represent--die every year because of hospital-acquired infections.

Senator Harkin tells me that it is the fourth leading cause of death--hospital-acquired infections. They don't care if you are insured when it comes to hospital-acquired infections. The insured will get one just as quickly as the uninsured. The quality provisions of this bill will prevent that and diminish that. That number should be under 5,000. It should be a rarity. Instead, it is a commonality. The system has to change for that to happen.

If you have an illness, try to find a prevention program. Ask anybody you know where they can go to find somebody who will support them in getting an appropriate, sensible, supported prevention program for themselves. It is rare to find. It is almost impossible. As I said earlier, when I was talking about the person who had a leg removed for $30,000 because there was nobody there to prevent them from letting that disease get to that stage, there are big savings there. It is a human consequence. You can have all the insurance in the world, but if it doesn't have a prevention option, you are not helped.

The last thing I will say is that so many of us who feel comfortable right now with our insurance only feel that way because we have had the good luck not to have the experience of having some loved one or ourselves get very sick. People's viewpoints change when they have had that experience. They find the limits of their policy. They see how fast the copays add up. They see the fine print in what they thought was a great policy when times were good and they were healthy, with just a little injury here and there, and everything was taken care of fine; but when they got really sick they found that policy they thought they could count on wasn't there for them.

Now the leading cause of families going into bankruptcy and losing everything in this country is somebody in the family having a health care disaster that wiped them out. That should not be. It happens over and over and over. It happens to the insured. That is not the uninsured. If you are uninsured and you have medical bills, you know you will have problems, but it is the insured who are caught by surprise. They have their homes, their stock portfolios, perhaps, on the side; they have a nest egg, and maybe they help support their children a little bit. And, boom, comes the illness and suddenly they have all these costs and these bills and it is piling up and they cannot keep up and they start to get behind. Before you know it, they have lost it all, and they are in bankruptcy.

Americans have that experience every day and every one of us have heard from somebody in our State who is right there. So I think the point the chairman has been making, and Senator Merkley made, about how important it is for people who have insurance, in terms of improving their lives, their quality, and their care and prospects is very poor. I applaud the Senator for having made that point.

Mr. President, I ask unanimous consent the order for the quorum call be rescinded.

I ask unanimous consent to speak in morning business for 12 minutes.

Mr. President, I met in my office today with Donna, a Rhode Islander who suffers from vascular disease. Donna's condition forced her to give up her job, and therefore her insurance. She cannot afford to buy it on her own, since it would cost her $650 a month-- money she does not have. So she pays for her medications out of pocket. They should be $2,000 per month, but her doctor got them down to $450. But even this is no walk in the park. Donna read me a laundry list of procedures and services she needs but cannot afford, so like so many Americans, she sits waiting, struggling, hoping she does not get worse.

I want to tell my colleagues what I told Donna today: the Affordable Health Choices Act, the bill that the HELP Committee passed out last Wednesday, would mean hope and change and help for Donna. It would mean that insurance companies could not deny her a policy because of her vascular disease, as they can, and do, right now. It would mean that insurance companies could not charge her sky-high rates because of her vascular disease, as they can, and do, right now. It would mean that if Donna needed financial help to purchase a health insurance plan, she would get it. No preexisting condition exclusions, affordable premium rates, and subsidies for those who need help purchasing a plan. That is what the HELP Committee's plan offers every American in this country.

I also have heard from Madeleine, a Pawtucket resident who cannot afford health coverage despite working two jobs. Her family has a history of colorectal cancer; both her sister and mother lost their fight to this disease. Tragically, Madeleine cannot afford to get a colonoscopy. Without insurance, Madeleine waits and hopes that she doesn't get sick, because that is the only option she has.

Under the Affordable Health Choices Act, Madeleine would have the financial help she needs to buy a comprehensive, affordable plan. But even before she did that, even before everything is in place for Madeline to go to a gateway and buy a plan, she could sign up for the Right Choices program. Under Right Choices, even without insurance, Madeline would have access to all basic preventive services. She would get a chronic disease health risk assessment, a care plan, and referrals to community-based resources. Most importantly, she would get the colonoscopy she needs, so that she is not another victim of the terrible disease that took her mother and her sister. It goes without saying that preventing this disease and treating it early would, in the long run, save money for the healthcare system as well as preserve Madeleine's health.

I recently had coffee with Shirley, a Middletown resident who described her relief at turning 65. For the past 20 years, she and her husband did not have insurance. As self-employed business owners in their fifties, finding affordable insurance options was impossible, so they went without. They took their chances. Now 65 and eligible for Medicare, they finally have peace of mind. Shirley admits she and her husband were lucky to make it through those 20 years without serious health problems. During our meeting, she urged us to pass health care reform for the millions of hard-working Americans--hard-working, middle-class Americans--who are not as fortunate as she and her husband.

Under the bill passed by the HELP Committee, Shirley would not have endured 20 years of fear and uncertainty without health insurance. As a self-employed, small business owner, Shirley would be eligible for tax credits to either continue to offer health insurance to her employees, or to offer it for the first time. Shirley could also take all of her employees to the health insurance gateway, which will give small firms a choice of multiple insurance plans at a lower cost and of a higher quality than what currently exist in the small group market. If you are a small business owner, this bill is for you.

Judith from Warwick, has shared with me a story about her brother-in- law, whose lungs collapsed during an outpatient procedure. After staying in the intensive care unit for 28 days, he contracted a hospital infection and was rehospitalized four times. Thankfully, a year later, he is symptom free. However, the costs stemming from the treatment totaled over $500,000. Like her brother-in-law, Judith and her husband are retired and live off of their monthly Social Security check. She reflects that on such a limited income, if she or her husband faced a catastrophic health issue like her brother-in-law, they would be in ``dire straits.''

The HELP Committee bill creates a Patient Safety Research Center at AHRQ, which will support research, technical assistance, and process implementation grants to local providers to teach and implement best practices. No one should go through what Judith's brother-in-law did. No one should contract a hospital infection that leads to not one, not two, not three, but four rehospitalizations. We know how to prevent hospital-acquired infections; we have seen tremendous results in places like Michigan and Rhode Island for years. The HELP Committee bill finally creates a national infrastructure to support the dissemination of these proven techniques so that we can drastically improve the quality of care in our system, and in doing so, drastically lower the cost.

Finally, I recently met David, a self-employed resident from Central Falls, who described the astronomical rise in the cost of health insurance for him and his waif. Years ago, he paid $85 per month for their plan; today, he pays approximately $19,000 a year for their health insurance. Despite the dramatic jump in price, their health insurance plan does not cover as much as it used to. To keep their premiums and overall health costs down, David has been forced to drop dental coverage and increase the out-of-pocket expenses he and his wife pay on their plan. He noted, ``I'm almost afraid to get sick, because today's health plans have so many holes in them, they can nickel and dime you to death.''

The Affordable Health Choices Act would do two important things to help David. One, it would require that plans sold in the gateway offer a truly comprehensive set of benefits so that ``affordable'' does not mean ``skimpy.'' Affordable will mean inclusive, available, and accessible. Two, the bill would not allow insurance companies to ``nickel and dime you to death'' as David fears now. Insurance companies would be prohibited from imposing lifetime or annual limits on the dollar value of benefits for any enrollee. So David will not be forced to pay out-of-pocket once he exceeds certain levels of benefits, as he does now.

There is some uncertainty both in this building and around this country right now about the future of health reform. I want to remind everyone--my colleagues on both sides of the aisle, my colleagues in the House, Rhode Islanders back home, and Americans

across the country, the Senate has already put forth a health reform plan that will work for you. It will work for sill-mil businesses. It will work for Americans with pre-existing conditions. It will work for Americans struggling to pay health care premiums. It will work for Americans who are in small businesses. It will work for Americans who are one illness away from their family going into bankruptcy. It will work for Americans who are uninsured. It will work for Americans who have been victims of hospital errors. It will work for Americans who need preventive services they cannot afford.

Most importantly, it will work for Donna, for Madeline, for Shirley, for Judith, and for David, and it will work for their fellow Americans all over this country whose stories are all too similar. Heartache, frustration, exhaustion, and disgust with a health care system that has, at best, disappointed them, and at worst, turned its back on them. The Affordable Health Choices Act offers these Americans a hand up when they need it most, and I am proud to support it.

Before I yield the floor, I want to take one moment to thank the distinguished senior Senator from Iowa for his courtesy in allowing me to proceed. I know he has substantial remarks he wishes to deliver. I hope it was not too much of an inconvenience.

I yield the floor.

Mr. President, if the distinguished Senator from Oregon would care to complete his remarks, I would have no objection. I don't suspect anyone else would.

Absolutely.

Mr. President, while we await the arrival of Senators who may be interested in offering their amendments, I ask unanimous consent to speak for up to 12 minutes in morning business.

Mr. President, I rise today to join my colleague from Oregon in discussing the challenges and opportunities America faces as we look to ensure our economic leadership and prosperity for the 21st century and beyond.

America has always been a land of innovation and entrepreneurship. We led the way during the industrial revolution, which began at Slater Mill in Pawtucket in my home State of Rhode Island. We led the way in the information technology revolution that began in Silicon Valley. It is in American DNA to think boldly and through hard work to translate bold thinking into practical solutions, solutions that improve people's lives all over the world and bring prosperity to our shores.

It is time for us to lead again. A clean energy economy beckons, and we must not, we cannot ignore the call. Congress must act to pass clean energy legislation that will promote, here at home, cleaner, cheaper renewable energy sources such as wind, solar, and biofuels. I stand here today in strong support of such legislation.

Our transition to a clean energy economy is past due. This country has run on the same fuels at basically the same efficiency levels since the start of the industrial revolution over a century and a half ago. This was acceptable in 1900, perhaps even in 1950, but where does it leave us today, in 2009?

First, it leaves us dependent on foreign oil. Approximately 40 percent of our energy needs are met through oil, and more than 70 percent of this oil, at a cost of $630 billion out of the American taxpayers' pocket every year, comes from foreign sources including Saudi Arabia, Venezuela, and other regimes that do not wish us well. It is the largest transfer of wealth in history, and we are on the losing end of it, and international big oil is only too happy to profit off America's decline.

Second, while we enrich hostile foreign governments and international big oil, other countries have embraced the development, manufacture, and export of renewable clean energy technology, such as wind turbines and solar panels, so that now half of America's existing wind turbines are manufactured overseas. The United States invented the first solar cell, but we now rank fifth among countries that manufacture solar components. The United States is home to only one of the world's top 10 companies manufacturing solar energy components and to only one of the world's top 10 companies manufacturing wind turbines.

Recently, two wind turbines went up in Portsmouth, RI. One was manufactured by Vestas, a Danish company, and the other by an Austrian company with a Canadian distributor that delivered the components to Rhode Island. These turbines are very welcome. It was like a barn raising when they went up. People came out to watch. As a result, Rhode Island and America got the benefit of cleaner, cheaper energy, but we missed out on the manufacturing jobs these projects should have created for American workers.

Other countries that have embraced the demand for clean energy technology, such as China, Germany, Japan, and Brazil, are all investing more per capita in clean energy than the United States.

I ask unanimous consent to have printed in the Record a Washington Post article dated July 16, 2009, ``Asian Nations Could Outpace U.S. in Developing Clean Energy.''

We have some catching up to do, and while we do that catching up, millions of Americans are out of work.

My home State of Rhode Island has one of the highest unemployment rates in our country. Across my State and across our country, couples are sitting at the kitchen table at night after the kids are in bed, with the bills on the table in front of them, and they are trying to figure out how to make ends meet and it is not adding up. That is the reality many Americans face when we cling to the failed policy of the past, when we care more about keeping big oil happy than about finding new, inventive ways for the average American worker to find lasting, secure employment in the tradition of American entrepreneurship.

Remarkably, there are those in Congress who would have us do nothing, who would remain wedded to tired, centuries-old technologies and left in the dust as other nations race for leadership in the new clean energy world. I submit this do-nothing caucus is selling America short. Don't they trust that when it comes to inventing new technologies and manufacturing valuable products, we are the best in the world?

If Congress passes strong clean energy legislation that creates the necessary incentives for the research, development, manufacture, and sale of clean energy technologies, that spirit of innovation and entrepreneurialism will again lead the world, as it has so often over the centuries. We can have confidence in that.

We have already seen some progress. It is clear, at least, that people outside the beltway get it. In the last 10 years, jobs in the technology sector have grown nearly 2\1/2\ times faster than overall. In 2006 alone, the American Solar Energy Society estimates that Federal, State, and local governments spent $8.6 billion on energy efficiency, creating 64,000 direct jobs and 83,000 indirect jobs. Their investment of an additional $3.2 billion in expanding new energy production created more than 7,000 direct jobs and nearly 9,000 indirect jobs.

Every day in America, real people and real companies are moving into the clean energy economy. In Rhode Island, Newport Biodiesel is producing a cheaper form of home heating oil for Rhode Island families by recycling restaurant grease. Alteris Renewables is creating jobs in Rhode Island installing solar energy systems on residential homes. I recently visited a home in Charleston, RI, where a family has a new Alteris solar energy system on their roof and heard from them about the significant energy savings they will achieve.

But this is only a fraction of the scale needed to revolutionize our economy. The American people, our researchers, entrepreneurs, and workers from the largest, most sophisticated research institutions and corporations to our smallest local businesses, can create clean energy jobs everywhere in the United States--in urban areas as well as rural, in the Rust Belt as well as the Wheat Belt, in our deserts and on our coasts. All they need is for us in Congress to set the economic parameters correctly, to level the playing field with foreign competition, to meet the market for investment in these products. America is waiting for Congress to act.

As I close, let me address a couple of the points we often hear from the do-nothing caucus and their see-nothing supporters in the boardrooms of the big polluters.

First, we simply cannot drill our way toward a secure energy future. It would take 10 years before we would see any tangible results from drilling, and the result would be negligible when it came. The United States has only 3 percent of known oil reserves. Yet we use 25 percent of the world's oil production. We cannot drill our way out of that math. The United States could supply 20 percent of our energy needs through wind power alone, not even factoring other forms of renewable energy.

The choice is a clear one for the future: Do we continue to enrich ExxonMobil and continue our dependence on foreign oil from places such as Saudi Arabia and Venezuela or do we decide to lead the world and tap into America's most abundant resource, the innovation and entrepreneurship of the American people?

We should also be skeptical of the champions of the status quo when they exaggerate the cost associated with transitioning to a clean energy economy. Our CBO has projected that clean energy jobs legislation would cost most American households on average less than a postage stamp per day, and it actually puts money back into the pockets of the poorest families, and that didn't even consider the savings to individuals and companies from energy efficiency practices and technologies. If prices go up a little but efficiency reduces demand and reduces use, families save. They always leave that part out of their see-nothing scenarios. We can easily increase our energy efficiency to cover 15 percent of our energy needs by 2020 and save American families and businesses nearly $170 billion in electricity costs.

Of course, the do-nothing caucus overlooks the cost of doing nothing. Unchecked greenhouse gas pollution has already begun to melt our glaciers and warm our oceans, leading to stronger, more frequent storms and rising sea levels. America's insurers are

worried about our coasts, home to over 53 percent of the U.S. population, where we generate over 83 percent of our gross domestic product. We put a lot at risk if we follow the lead of the do-nothing caucus.

We have heard the ``Do Nothing Caucus'' argue that strong environmental legislation would hurt the economy and cost us jobs. It is the same old polluters' argument. It is as wrong now as it has always been before.

In the 1990 debate on the acid rain program, manufacturers warned that the health benefits of the program were unclear and that their adoption could deal a ``crushing blow to U.S. business.'' But when the acid rain program was enacted, the program began delivering $70 billion annually in human health benefits, at a benefit-to-cost ratio of more than 40 to 1. Industry and environmentalists alike now agree the program was a success. Oops to that argument.

In 1995, DuPont warned the costs of phasing out ozone-depleting chemicals would exceed $135 billion and that ``entire industries would fold.'' But when the phaseout became law, compliance costs turned out to be less than 1 percent of the doomsday projection. DuPont made millions selling substitutes for the phased-out chemicals, and we managed to shrink the hole in the ozone layer of our Earth's atmosphere. Oops again.

We are at a crossroads. We can step toward the clean energy economy that beckons and show the world our capacity for leadership in the world economy, as we have done time and time again, or we can cling to the status quo, heads firmly wedged in the sand, and trade in our future for the well being of big oil and the Saudi Arabia royal family.

The right choice is clear, and I am confident we will make it.

I yield the floor.

The PRESIDING OFFICER (Mr. Merkley.) The Senator from Texas is recognized.

Tort Reform

Mr. President, I ask unanimous consent to speak as in morning business for up to 15 minutes.

I would let the distinguished floor manager and the distinguished Senator from Utah know that if someone does come to the floor and wishes to do their thing with an amendment, please feel free to give me the high sign and I will conclude my remarks and allow the business of the floor to proceed. I do not wish to keep anybody from offering an amendment, if they have one.

But I did wish to take the time to talk for a minute about our health care system because I think people across the country are, right now, finding our dialogue in the Senate a bit confusing about health care, and they are starting to wonder what is going on. In particular, particularly for those who have insurance: What does this mean for me? Why is this important for me that the Senate be doing this work? I already have insurance. What do I stand to gain from all this?

There are a great number of things Americans stand to gain from all this. But the issue I wish to focus on today is improvements in our delivery system. It is important for Americans who are listening to realize that the personal experiences so many of them have had are not unique. If you have had a loved one in the hospital and you have felt constrained to stay with that loved one through their illness in the hospital, if you have felt you could not leave them alone in that hospital for fear that something might go wrong, some drug might be misadministered, some call might go unanswered, if you feel that way, if you have had that experience, you are not alone.

That is an extraordinarily common experience. If you have felt you missed an opportunity for the prevention of illness, nobody told you that you should have had this test, nobody told you this was a health consequence of something you were doing, that is an experience Americans have across this country.

If you have had to ferry by hand your health records from place to place or if, similar to many Rhode Islanders, you have been rushed up for emergency specialty care in Boston and your paper records did not come with you and you have been in real peril in a Boston emergency room as they try to redo the tests they did not have access to because you did not have a comprehensive electronic health record, you are similar to many Americans.

The consequences of that, of those problems, are renown throughout the health care system. The problems they cause are real ones. There are 100,000 Americans who die, who lose their lives every single year because of completely avoidable medical errors, most of them hospital- acquired infections. That is intolerable. That is a plane crash a day. Yet it is the status quo in the existing health care system.

We have the worst health care outcomes of essentially any civilized developed country we compete with. The worst. Even though we pay twice as much per person for our health care than most of them, we have worse outcomes. That is the status quo of our health care system. The Economist magazine has reported that the health information technology infrastructure that supports our health care sector is the worst of any American industry, except one, the mining industry.

That is not very reassuring, not in an industry where the possibilities for technology are so great, and where at the detection end and where at the treatment end, we are at the technological cutting edge of the world, but you get back to that back office and there you are with that paper record and no way to cross-reference for drug interactions.

We are at a primitive stage with our health information infrastructure. That is the status quo of our health care system. Everybody, I suspect, has had the experience themselves or of a loved one who becomes sick unexpectedly who turns to their insurance company, the insurance company they have been writing those big checks to year after year, only to find out that when you turned to that insurance company in your hour of need, they turned on you, they turned against you.

They tried to figure out a way to get you off coverage. They tried to talk you out of the coverage and the treatment your doctor has indicated. They fought with your doctor about whether they would pay it. For many people, the experience is not just of being the patient, the experience of being the spouse or the family member or the loved one of the patient who has to cope, who has to become the person who answers the deluges of mail, who makes the call after call after call, who waits through dial tones and through the voice mail and the voice messages to try to get to somebody to approve procedures the doctor has said you need. That is the status quo of our health care system-- millions of Americans told by their own insurance companies: Forget it. We are not going to pay for the treatment your doctor says you need.

The major reason American families go into bankruptcy right now is because of health care expense. It is not just the uninsured. These are insured families who find their coverage limits have been reached, who find the insurance company has found a loophole, who find they have exceeded, in terms of all the peripheral costs of durable medical equipment and other things that might not be covered, but it is more than they can bear to get by and they are struggling to get by and they are dropped into bankruptcy; the most prominent reason American families go into bankruptcy.

That is the status quo of our health care system. Those can all be better. We can revolutionize all those areas. We can revolutionize the quality of care and the safety of Americans when they are in the hospital.

We can improve our health care outcomes so we are the pride of developing nations, and not the lagger. We can improve so we do not have the worst health information technology of any American sector. We can eliminate denials of care by insurers for preexisting conditions. We can provide adequate supports to Americans so bankruptcy is not a common symptom of illness in this country.

The problem is, if we do not do anything about those existing problems, they are all going to accelerate. They are all getting worse. What do we have to look forward to? Well, we have to look forward to a $35 trillion Medicare liability, and we do not have $35 trillion to spend.

That is a future liability. It is coming toward us. The people who are going to cause it are alive right now. They are not going anywhere. They are getting older every day. Time is not going to stop. And they are getting sicker every day because it is never going to happen that older people are healthier than younger people.

There is a tsunami of health care costs bearing down on us. Just the Medicare slice of it is a $35 trillion liability for our country, and we do not have the $35 trillion. So it is either going to wreck us or we are going to have to take some very smart, very aggressive measures now to reduce those costs.

If we do nothing, a family in Rhode Island in the year 2016--that is not too far from now; that is 7 years from now--a family in Rhode Island making $52,000, which is a pretty good income, a family making $52,000 will spend more than half their income on health care. By as soon as 2016, a Rhode Island family making $52,000 will spend more than half their income on health care.

We use the word ``unsustainable'' around here. We are headed to where it is impossible for regular families to get health care. It is bad enough now, and it is getting worse. We have to act to stop it from getting worse.

We have pretty close to lost our car industry. People used to say: What is good for GM is good for America. It was the emblematic American company. It is gone. It is in bankruptcy, and it is gone. It is now coming back out of bankruptcy, but it had to be swept through a bankruptcy. The catastrophic effect on our country of the loss of those jobs in the Midwest and then through the secondary providers across the country is a very real problem, and it is being felt in large part because those cars were so burdened with health care costs.

If you go to Starbucks, there is more health care money in your coffee than there is coffee bean money. In those cars, there was more health care money than steel. The cost of health care per car was greater than the cost of steel per car. It is pretty hard to compete with Volvos and the Lexus and cars from places where they have a national health care system and the price of the health care is not buried in the cost of the car. It put our workers at a terrible disadvantage. That is only getting worse, and our manufacturing sector has enough problems without continuing to load health care costs on to it. If we can't get the message from the collapse of the auto industry, we are missing some very loud--indeed deafening--signals.

Our last Comptroller General warned that this health care mess will sink our ship of state. He phrases it as a national security issue to get this right. He left the job to go and spread the word around the country warning us of what is coming.

Not only is it bad now, it stands to get a lot worse. Here is the opportunity and the tragedy of this: It is that so much of this is waste. One recent voice on this subject is a former Cabinet member from the last administration. Paul O'Neill was the Secretary of the Treasury of the United States. He is no fool. He is a sensible and thoughtful man. He ran, for years, Alcoa, one of America's biggest corporations. He has extreme business experience. He also ran something called the Pittsburgh Regional Health Initiative which looked at improving the quality of care of hospitals in the Pittsburgh area. He was a leader in all of this. He knows his health care issues well. Here is what he wrote recently: There is $1 trillion of annual waste in the health care system that is associated with process failures. A trillion dollars a year--even by Washington standards that is a big number. That is a target that is worth shooting for. That is a target that we shoot for hard in the legislation we are putting forward.

If we take a look at the President's own Council of Economic Advisers recent report, on July 9, a few weeks ago, they put out the report on the economic case for health care reform. They looked at the health care system from two measures: one, if you compare to it foreign countries and look at their gross domestic product share and extrapolate from that, what we could get our costs down to if we were sensible and thoughtful and didn't have such a wasteful health care system and, second, to look at the variation among the States, from State to State, from region to region, even as the recent article by Atul Gawande said, the differences within a State, between McAllen, TX and El Paso, TX.

If you look at those, that gives you another means of calculating what you could get the costs down to. If you could get the waste out of the system, efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of U.S. GDP. From the Council of Economic Advisers, that is over $700 billion a year. Maybe it is a trillion, maybe it is $700 billion. Per year that is a big number.

Looking at the internal discrepancies, they note:

[It] should be possible to cut total health expenditures by

about 30 percent without worsening outcomes [which] would

again suggest that savings on the order of 5 percent of GDP

could be feasible.

Again looking at the calculation two separate ways, coming to the same number, $700 billion a year. The problem is, it will take some executive administration to get there. It is not easy. You don't just make your decision, flip up or down the light switch, it goes on, and you don't have to worry about it. This isn't like the sniper who lines up his shot, pulls the trigger, and the projectile goes. This is a problem where you are like the pilot landing in rough weather. You have to continue to steer through it. You have to continue to seek the savings. As the market adapts, you have to adapt with it. It takes executive leadership and administration to make this happen. That means the Congressional Budget Office can't score it. All they can say is that it promises a ``large reduction'' in American health care costs. But they can't score it.

So the American public, with a lot of misinformation out there, has been beguiled into believing that what we are doing won't save money. We are determined to save money doing it. The Medicare system and the American health care system and the American economy will fail if we don't save money doing this. The target is as big as $700 billion to $1 trillion a year.

Our health care system has been described memorably as a ``carnival of waste.'' It is time to bring the carnival to an end and give Americans the health care they deserve.

There are a couple of pretty sensible ways to do this. The administration has focused on all of them. The first is, as I said earlier, health information infrastructure. Why should every American not have an electronic health record? Why, when you go to McDonald's, should the checkout person have a more robust health information infrastructure backing them up and connecting to inventory and connecting to sales than your doctor does? It makes no sense. We could save enormous sums if we had a national health information infrastructure--secure, confidential, reliable, interoperable. So if you went to get a lab test, it went into your record. If you went to the emergency room, it went into your record. If you stayed at the hospital, it went into your record. If you saw a specialist, it went into your record. All of your practitioners would know what was going on in your care. The more complex and chronic your conditions, the more valuable that would be. We don't have that now. It is the worst of any American industry except the mining industry.

Quality improvement: In Michigan, there was a fascinating project, called the Keystone Project, where they went into the intensive care units in Michigan--not all of them but a great number of them--with process reforms in the intensive care units to reduce respiratory problems from not being elevated, to reduce line infections from catheters and from blood lines. The effect of that was, in 15 months, to save 1,500 lives and $150 million just in one State and not even all the intensive care units. It proves the proposition that quality improvement can save money and lives.

Prevention is obviously the same. We will be on the floor shortly to debate Judge Sotomayor's nomination. She has lived with diabetes since she was a child. She has taken good care of herself so she had not created a lot of cost for the health system, but many people who don't manage their disease well, who don't get the prevention they need, end up with amputations, blindness, long and unnecessary hospital stays. There are areas where, by investing in prevention, we can save fortunes.

Why don't we do this then? Why don't we have electronic health records on every doctor's desk for all Americans? Why don't we have every intensive care unit participating in a Keystone-type quality initiative? Why doesn't every community health center have a robust diabetes prevention program? It has to do with the bizarre economics of our health care system. Because the same thing is true for all three entities. If you are a doctor and you want to put electronic health record systems in for your patients, if

you are a hospital and you want to improve the quality of care in your intensive care unit and put in a program that will do that, if you are a community health center that wants to invest in prevention to help the diabetic population stay healthy, you face the exact same predicament: The investment you have to make is 100 percent out of your pocket. The risk of the investment is 100 percent on your neck. The administrative burden is 100 percent on you. The hassle of it is 100 percent yours. All of the costs are on the desk of the doctor, on the desk of the hospital administrator, on the desk of the community health center. But the benefits from the electronic health record, the benefits and the savings from the quality improvement, the savings and the benefits from the prevention don't find their way back to that same desk. They go off to Medicare. They go off to the insurance industry. They connect to the patient in better care, but investment doesn't get the reward.

The basic principle of American capitalism, which is the connection between risk and reward, has been broken in the American health care system. That is one of the things we get after in this bill. We could have electronic health records for every American, our hospitals and doctors highly motivated to pursue all the quality initiatives that will improve the quality of our care while it lowers the cost and avoids unnecessary hospitalizations and delays and infections, and so forth, and we could have the best prevention program in the country, but we have to make it work for people. That is part of what we are about in this health care reform.

I will continue to explain why it is important that we reform our health care system and what the average American will gain from it. Today I focused on the elements of why delivery system reform can be improved. But every American will see that in their lives, their parents' lives, and in their children's lives. When we look back to where we are today from where we can be and where, with President Obama's leadership, we will be, we will look back and ask: My God, how could we have been living that medieval setup? Look how good it is now.

That is our goal. That is our purpose. That is the promise of health care reform.

I yield the floor and suggest the absence of a quorum.